Dosing Cefazolin for Surgical Site Infection Prophylaxis in Adolescent Idiopathic Scoliosis Surgery: Intermittent Bolus or Continuous Infusion?-A Pilot Study.

Background: Cefazolin may minimize the risk of surgical site infection (SSI) following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Cefazolin dosing recommendations vary and there is limited evidence for achieved tissue concentrations. Methods: We performed a randomized, controlled, prospective pharmacokinetic pilot study of 12 patients given cefazolin by either intermittent bolus (30 mg/kg every 3 h) or continuous infusion (30 mg/kg bolus followed by 10/mg/kg per hour) during PSF for AIS. Results: Patients were well matched for demographic and perioperative variables. While total drug exposure, measured as area-under-the-curve (AUC), was similar in plasma for bolus and infusion dosing, infusion dosing achieved greater cefazolin exposure in subcutaneous and muscle tissue. Using the pharmacodynamic metric of time spent above minimal inhibitory concentration (MIC), both bolus and infusion dosing performed well. However, when targeting a bactericidal concentration of 32 µg/mL, patients in the bolus group spent a median of 1/5 and 1/3 of the typical 6 h operative time below target in subcutaneous and muscle tissue, respectively. Conclusions: We conclude that intraoperative determination of cefazolin tissue concentrations is feasible and both bolus and infusion dosing of cefazolin achieve concentrations in excess of typical MICs. Infusion dosing appears to more consistently achieve bactericidal concentrations in subcutaneous and muscle tissues.

The use of a noninvasive positive pressure system to facilitate tracheal intubation in a difficult pediatric airway: a case report.

Patients with burns to the head and neck may be difficult to intubate or ventilate via facemask. Furthermore, post-burn scarring and microstomia may reduce the success of rescue supraglottic airway placement. While awake tracheal intubation using a flexible intubation scope is considered the optimal technique for these patients, it may not always be feasible in the pediatric population. We report a case of successful management of a difficult airway in a child with extensive post-burn head and neck deformity using a noninvasive positive pressure system to aid with inhalational induction and deep sedation during intubation using a flexible scope.

The use of a noninvasive positive pressure system to facilitate tracheal intubation in a difficult pediatric airway: a case report

Abstract Patients with burns to the head and neck maybe difficult to intubate or ventilate via facemask. Furthermore, post-burn scarring and microstomia may reduce the success of rescue supraglottic airway placement. While awake tracheal intubation using a flexible intubation scope is considered the optimal technique for these patients, it may not always be feasible in the pediatric population. We report a case of successful management of a difficult airway in a child with extensive post-burn head and neck deformity using a noninvasive positive pressure system to aid with inhalational induction and deep sedation during intubation using a flexible scope.

Simultaneous Retrodialysis by Calibrator for Rapid In Vivo Recovery Determination in Target Site Microdialysis.

Concentrations in the interstitial tissue space are of clinical interest for many antibiotics and can be directly measured by microdialysis. Quantitative microdialysis strongly depends on reliable recovery estimates obtained from a suitable calibrator. Cefazolin (CFZ) is frequently used as a prophylactic antibiotic to prevent surgical site infections. This study aimed to develop a reliable and rapid calibration technique for CFZ microdialysis using cefuroxime (CFR) as a calibrator, which is applied simultaneously in the opposite direction via retrodialysis. Liquid chromatography-tandem mass spectrometry method was used for the measurement of both CFZ and CFR in microdialysate. Results from in vitro microdialysis experiments confirmed that CFR does not interfere with physicochemical properties of CFZ, and the loss of CFR is proportional to the gain of CFZ in microdialysis studies. Therefore, the validated bioanalytical assay is suitable to be applied in clinical microdialysis study of CFZ where microdialysis probes are simultaneously calibrated by retrodialysis of CFR. This approach shortens the overall sampling time of in vivo microdialysis studies significantly since calibration and sampling can be performed simultaneously and not in sequence as usually done. It also eliminates the necessary washout period if probe calibration is carried out before the actual sampling time.